Healthcare Provider Details

I. General information

NPI: 1831363258
Provider Name (Legal Business Name): KENNETH E. PETRI M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E HARVARD AVE #250
DENVER CO
80210-7009
US

IV. Provider business mailing address

950 E HARVARD AVE #250
DENVER CO
80210-7009
US

V. Phone/Fax

Practice location:
  • Phone: 303-871-9585
  • Fax: 303-871-9751
Mailing address:
  • Phone: 303-871-9585
  • Fax: 303-871-9751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15874
License Number StateCO

VIII. Authorized Official

Name: KENNETH EDWARD PETRI
Title or Position: OWNER
Credential: MD
Phone: 303-871-9585